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  1. #1
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    Exclamation shoulder bulletproofing: rarely about Rotator Cuff strength

    This post started as a discussion about exercises for the rotator cuff as a strategy many folks seems to think helps "bulletproof" one from shoulder injury. This approach speaks to a misunderstanding it seems of the mechanics of the shoulder and where injury in the shoulder generally begins.

    IT's interesting why folks think RC muscle building offers any kind of bullet proofing.
    I guess we think wow if my shoulder's gone funny it's cuz a muscle wasn't quite doing its job.

    Unfortunately while this is a common view it's not high enough up the stack. Before our muscles fire, our brains and nervous system are involved (then the rest of our body connected to the shoulder).

    Before muscles fire, our nervous system is making decisions about what it will and won't let move. SO before we think about our muscles and working on them as a solution, we need to get further up the control stack to see if ITs happy to let our shoulders do what we ask them to do.

    shoulder injuries about the brain not the muscles
    True story: see LOTS of shoulder injuries - been there myself -
    In my practice, and the clinical experience of my colleagues, the SITS group is RARELY (like 1 out of 100) the culprit for shoulder stuff.

    What all the athletes with shoulder issues have had in common are issues somewhere in their movement.

    Sometimes the issue is in their thoracic spine, sometimes in their hips, sometimes in their grip.
    Sometimes the movement/muscle issue is triggered by something higher up the stack like a vision thing; sometimes it's been a balance thing. Sometimes its been a little sensory motor amnesia in a wrist flexor causing weird compensations up into the shoulder/brachial plexus.

    Something at a higher level than the muscular system, such as in the sensory-motor systems, is not happy with letting the musculo-skeletal system do something.

    Makes sense: if you have a slight vision or balance issue why would your nervous system let you press a super heavy weight? And if you've never been tested for say a visual foria, then you wouldn't even know if your brain is constantly seeing things as further away and finding out they're actually closer: that's freaky; that's going to cause some performance shut down. And guess what? BB'ers traditionally have poorer visual acuity than any other sport. This may not be you, but if you ever hated ball sports as a kid, might be worth an eye check.

    If you have a balance issue and you compensate for it by leaning in one direction, or by taking a slightly wider stance - how offset migh be your press, such that doing lots of that in that sub optimal pattern might not hurt the shoulder that's not designed for that groove?

    any map in the brain for end of range?
    The biggest causes of injury in sport are
    - injuries that take place when decelerating
    - injuries at end range of motion.

    Let's suppose you have great movement - rare folks like this still *rarely* practice end range of motion work, so that when the move goes further back than anticipated, the nervous system has been there before and knows what to do. Without that practice the brain doesn't know what to expect; it freaks out, muscles get tight; injury occurs.

    There's an incredible amount of brain that goes into an injury: ever heard the stories about drunks who walk away from falling out a window or getting hit by a car? where a sober person is toast? The only difference is the brain and state of the nervous system. Works in the gym, too.


    so where do RC moves fit in?
    The only practical reason to do rotator cuff exercises is for BB to hypertrophy your teres and infra so they pop out. But does one need to do this for hypertrophy? Take a look at the backs of male gymnasts who do no isolation work at all. Do you see hypertrophied infra and teres?

    strategies to protect the shoulder
    The shoulder is an amazing set of lacings; the RC group of 4 muscles are characterized as active tendons more than muscles since their job is assisting other prime movers and keeping the shoulder in its socket.

    The best bullet proofing against shoulder injuries is regular dynamic movement practice; the best best insurance - see a movement specialist who can check out your vision, balance, proprioception in your movement to make sure ALL of you is working together as a well oiled machine.

    movement - quality joint by joint control - that's bulletproofing
    As said, big take away: shoulder injuries are rarely rarely rarely due to weak rotators. If you press, if you pull if you hinge, if you squat you will be bringing your rotators sufficiently to bear.

    Indeed it's rather impossible to pull or push without using these four stabiliser muscles that make up the RC
    (if you're interested in the mechanics here's two overviews,

    one of the scapula and SITS and one of the gleno-humeral joint
    http://www.begin2dig.com/2010/06/ama...-shoulder.html

    http://www.begin2dig.com/2010/06/ama...nohumeral.html)

    Not least because the SITS get SO MUCH work,
    Better to do movement work, and sometimes loaded mobility with bands in full range of motion work to help your BRAIN build up space and knowledge about how you can move that limb so its ready for you.

    It's this approach on the brain mapping quality movement that pretty consistently immediately gets the athletes i work with out of shoulder pain.

    best
    mc
    Last edited by mc-; 09-17-2011 at 11:11 AM.
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    Registered User thedogdidit's Avatar
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    Originally Posted by mc- View Post
    Not least because the SITS get SO MUCH work,
    Better to do movement work, and sometimes loaded mobility with bands in full range of motion work to help your BRAIN build up space and knowledge about how you can move that limb so its ready for you.

    It's this approach on the brain mapping quality movement that pretty consistently immediately gets the athletes i work with out of shoulder pain.

    best
    mc
    Thanks mc for this!

    I have mobility issues in one shoulder that I've had for years. No pain, though (Oh, it was painful initially! now it just has "issues" - lol).

    I realize I should see a movement specialist in person, but am wondering if, barring that, arm bars and turkish get ups are as miraculous as some of the stories I've read. I suppose I should just try ... I am curious if these would be included in the movement work you suggest, provided they're done properly?
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    Originally Posted by thedogdidit View Post
    Thanks mc for this!

    I have mobility issues in one shoulder that I've had for years. No pain, though (Oh, it was painful initially! now it just has "issues" - lol).

    I realize I should see a movement specialist in person, but am wondering if, barring that, arm bars and turkish get ups are as miraculous as some of the stories I've read. I suppose I should just try ... I am curious if these would be included in the movement work you suggest, provided they're done properly?

    Arm bars and turkish get ups are lovely movements to practice for general body movement control.

    If there's no pain in doing the movement, doing them can't hurt

    as to whether they will address your remaining issues - it kinda depends what the actual issue is. If it's a visual thing, or something with a muscle partially not firing, or something else somewhere else - will those movements dial in what would optimally take care of your stuff? not clear. Maybe you'll be lucky.

    This is why seeing a movement person can really help: it's really about test and reassess and having the tools to dial in the fastest path for ongoing, active self-tuning.

    So that's a great big "maybe" isn't it?

    That said as you say, you can only try.

    so let me repeat: perfect form and no pain - never move into pain - check it out

    and in answer to your question sure i'd include these movements as part of anyone's well being plan. why they'd be part rather than the whole? there's lots of great movement in the TGU - and it crosses plains - but does it take each joint through a complete range of motion so you can see if you can own each of those joints?

    So great approximation and much better than nothing at all.

    and in case you're curious
    here's both and overview and some questions about the TGU

    overview
    http://www.begin2dig.com/2008/08/ref...ish-getup.html
    why the high hip bridge
    http://www.begin2dig.com/2009/04/tgu...addresses.html
    and some questions
    http://www.begin2dig.com/2009/04/tur...-movement.html

    best
    mc
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    Just by way of update, just worked with a person who was having some residual shoulder issues. Turned out that what allowed relief and IMMEDIATE return to previous performance range of motion and pressing was a little support on one of the small tendons between the accromium process and the clavicle.

    We taped it with a wee bit of kinesio tape, rechecked, got him going doing some light end range of motion work with a really light theraband, and all sorts of good things opened up. In all sorts of other movements that didn't seem particularly related to the shoulder.

    I will not say that we hit the "cause" of the issue but that what we did openned up performance and seemed to be a good change.

    Remember pain is a signal for change, not a prescription for what to change.

    After about a week the tape came off (the stuff is waterproof more or less - well shower proof) and, possibly because of the work that we were doing with the shoulder to reinforce the tape effect, things have been happy ever since.

    This story is not about how great kinesio tape is - it's about that the site of pain is not the source - i was no where near the "site" of the dude's pain but i did have a variety of tests to let me assess up and around the chain to find some strategy that worked.

    This also doesn't mean that this is the ONLY strategy that may have worked.

    And how do we define worked?

    That when HE tested his movement actively the solution continued to work; that when we went through a range of movements where it had been a problem, pain was way down performance was way up.

    Test and reassess worked. If it hasn't we would have kept exploring.

    The site is not the source -
    i'll go one futher to say that our job as therapists/coaches mayn't be to find the "source" - but to find what works to let an athlete's performance come back - a side effect of this is that pain usually goes away as a result. they're linked.


    best

    mc
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    A lot of shoulder posts right now - hope this thread may help


    mc
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    Archwizard kanis999's Avatar
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    Are you saying that programs like Neanderthal No More, which serve to improve posture, relieve pain, and reduce the chance of injuries by correcting global muscle imbalances and strengthening local stabilizers don't really work?

    I need to know ASAP please, because I'm planning on starting my first day of Neanderthal No More in about two hours. I don't want to waste my time for 7 weeks. My intent with in doing this program is to let my lengthened, inhibited muscles catch up to my short, overactive muscles. Is there no true benefit to doing this?
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    Originally Posted by kanis999 View Post
    Are you saying that programs like Neanderthal No More, which serve to improve posture, relieve pain, and reduce the chance of injuries by correcting global muscle imbalances and strengthening local stabilizers don't really work?

    I need to know ASAP please, because I'm planning on starting my first day of Neanderthal No More in about two hours. I don't want to waste my time for 7 weeks. My intent with in doing this program is to let my lengthened, inhibited muscles catch up to my short, overactive muscles. Is there no true benefit to doing this?

    Well
    the shortest answer would be:
    what CAUSES those muscle imbalances - should they exist - in the first place?

    Muscles respond to signals from the nervous system. The nervous system responses to a pretty binary perception: threat or no threat.
    Address the threat (usually visual, vestibular, proprioceptive - or sometimes a chunk from some previous trauma) and suddenly performance opens up (which means quite often that pain goes down too).

    Heck i've worked with athletes who started performing better/reduced shoulder pain, just from loosening their shoe laces. Arthrokinetic reflex response.

    You may find the section of this post "i have tight hamstrings" helpful (scroll down)
    http://www.begin2dig.com/2010/11/wha...for-petes.html

    Hope that helps.

    mc



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    I see, very good answer. So when doing this program, the benefits have more to do with the nervous system's adaptation than the actual muscular adaptation?
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    Originally Posted by kanis999 View Post
    I see, very good answer. So when doing this program, the benefits have more to do with the nervous system's adaptation than the actual muscular adaptation?
    Wow, you know we're complex systems so saying categorically what's first what's second is kinda AAAHHH.

    Maybe i could put it this way: if the nervous system isn't happy you can do as much muscular or tissue work as you want and the problem will keep coming back. This effect is why i have a hard time with most people who constantly foam roll to "get out knots" - like dude, why do you have to KEEP doing this if it's really addressing the cause rather than the symptom of the problem? maybe it's not an optimal strategy.

    So to get to your question about "adapting" - where might that be taking place? If you do something - improve movement quality - such that your nervous system is happier it will let you perform better. But what is adapting? Well, it's your movement (movement pattern) as it becomes more consistently better.


    Now the thing about the NNM program is that, knowing about the nervous system being higher in the chain than the muscles, and that the nervous system will gait any other performance, the NNM program becomes a kind of a hack: where the WHOLE THING is what you need or the right thing for you and your nervous system is a big fat unknown.

    If you don't have a way to test whether or not your body likes what you're doing with these particular sets and reps then really we're just guessing and hoping for the best.

    The folks i coach don't have time to hack: our goal is to tune in what works for them, right now, that we can test that right now, and then find a way to drill that in so that yes those better quality patterns stick (generally understood as "motor learning"). The nervous system works fast - proprioception goes at 300mph. If a movement's working we can test it immediately. We have a bunch of assessments we can and do use.

    So maybe this program will be great for you; maybe it will be ok; maybe it will suck. If we're not testing we're guessing.

    If you'd rather dial in something right now, consider a movement assessment. you're in florida? The closest person i know is in Tampa; too far, more folks are also doing assessments via skype, too. so there's options

    all the best with your practice
    nice chatting with you

    mc
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    Archwizard kanis999's Avatar
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    Thanks, that was a very in depth, detailed answer. That makes a lot of sense. Without testing in a controlled manner, I am just stabbing at the dark hoping that NNM will address the problems. One thing I can say for sure after doing the program for two days is that the movements all feel very hard and a bit unnatural. This leads me to believe that I am indeed addressing weaknesses in my kinetic chains. With many of the moves I feel like I have to learn how to move differently, and recruit different muscles, which might be a good thing.

    Thanks again for your advice! I'll get a movement assessment soon if things don't start to improve in the next month or so.
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    A couple quick points
    I'm not a big fan of postural assessments -these are static. How do we move? That's where the money is. and since this post is about shoulders, how are your shoulders and thoracics moving? Are they?

    Also just looked over that 2004 program again and an abbreviated form that hits everything unit is coveted by doing two moves:

    Kettlebell swings
    http://www.begin2dig.com/2010/07/bea...ideman-on.html

    And


    Turkish getups
    http://www.begin2dig.com/2008/08/ref...ish-getup.html
    (see discussion above for value of tgu's to shoulders)

    Add some single leg deads, some kb frontsquats and farmers carries you're getting these moves
    Use a dan John two minute pushup plank test to see how you're doing

    I like simple things: where a handful of moves will get ya going with something you can do every day
    Throw in some mObility work everyday as suggested above, consider dynamic postural alignment while doing all your lifts well everything else largely takes care of itself

    mc
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    MC - Followed several of your posts and links to end up here, but I'm glad I did, if only for this quote:

    Remember pain is a signal for change, not a prescription for what to change.
    I think I'm going to have that tattooed on the inside of my eyelids.

    Thanks for the great posts!
    No shoes, no shirt, and I still get service.
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    Originally Posted by RMBros View Post
    MC - Followed several of your posts and links to end up here, but I'm glad I did, if only for this quote:



    I think I'm going to have that tattooed on the inside of my eyelids.

    Thanks for the great posts!
    glad you made it then.

    way to go with the no shoes...

    mc
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    Originally Posted by mc- View Post
    glad you made it then.

    way to go with the no shoes...

    mc
    Switched to barefoot running about a year and a half ago to toughen up my feet for sand volleyball. Here in TX, the sand gets to 120+ and I've always had trouble dealing with the heat when my feet blister - more blistering as I've grown older because I don't get to play/practice as much, all of which leads to more tender feet.

    Running barefoot on hot pavement and gradually increasing my shoeless time seemed to be an easy way to build up some tolerance, so I went for it.

    Now, I have a hard time running any other way.

    Haven't bought a pair of running shoes since then, haven't had any of the nagging injuries/soreness that niggled at me when I ran with shoes (extra cushy shoes, because I'm relatively big for a runner), and I could walk on hot sand as well or better than the kids who get to play VB 5 times a week.

    I try not to evangelize about BF running too much, because I don't think it's right for everyone, but I'm a convert for sure.

    Besides, I like doing whacky stuff anyway.

    Keep up the good work!

    Now, back to your regularly scheduled thread.....
    No shoes, no shirt, and I still get service.
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    just in case you're interested here's a series on barefoot running
    the why and how of it - and why getting bare soles in contact with the ground is a good idea
    http://www.begin2dig.com/2011/07/mic...-barefoot.html

    mc
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    I myself have had ongoing shoulder bursitis for over 2 years. It's almost completely gone as I have been doing the proper exercises and stretches for it.

    I still get some pain when doing any sort of overhead movements and like military presses or dumbbell presses. Although for some reason hand stand pushups caused me no pain. Personally, I found that the kettlebell jerk helped me the most in rehabilitating my shoulder.

    I have always wondered with shoulder bursitis, why does lifting a heavy kettlebell dynamically overhead in the kettlebll jerk cause no pain, but lifting a light dumbbell overhead cause some pain. Is it to do with the activation of the stabilizers of the shoulder joint in the kettlebell jerk vs dumbell overhead press?
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    when it comes to pain there is no "the answer"
    all we know is that if pain is happening there's something going on in whatever is special about that movement that is firing off "problem" -

    there are various techniques to help reel that in.
    glad you're finding the jerk working.

    likewise about headstand push ups - they can be a real tonic for folks having trouble with presses from shoulder issues: similar but different enough to help work and heal an area.

    best
    mc
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    just wondering who's been trying pain free movement work as an approach to healing their shoulder pain?

    mc
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    Good post mate!!
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    thanks David, best with your recovery
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    Registered User Emh125's Avatar
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    Originally Posted by mc- View Post
    just wondering who's been trying pain free movement work as an approach to healing their shoulder pain?

    mc
    mc,

    I have been fighting with some nagging shoulder pain that came from bad form in bench press. I have read most of your posts in this forum but I am still having a problem. The idea of not moving into the pain makes complete sense but the pain I get in my shoulder does not happen during the press. Rather, it will start to hurt a couple hours after I do a pressing movement. Since the pain comes later, I don't know what rom I can go through in a press. Do you have any suggestions for me?

    Thanks for your posts, they have been very helpful.
    Erik
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    Originally Posted by Emh125 View Post
    mc,

    I have been fighting with some nagging shoulder pain that came from bad form in bench press. I have read most of your posts in this forum but I am still having a problem. The idea of not moving into the pain makes complete sense but the pain I get in my shoulder does not happen during the press. Rather, it will start to hurt a couple hours after I do a pressing movement. Since the pain comes later, I don't know what rom I can go through in a press. Do you have any suggestions for me?

    Thanks for your posts, they have been very helpful.
    Erik

    when i hear about such experiences i begin to think "technique" and muscle firing. Sometimes a muscle or tendon is being asked to take up more load when associated muscles are just not coming on. Sometimes it take a little cuing to help these come back on line. This is where it would help to have someone who knows what they're doing with muscle cuing check. OR something else might be going on. BUT IN ANY CASE - if you're in pain consistently AFTER doing presses, sport, back off the press for a bit and see how you feel. And if you really want to get to the bottom of this, see a movement specialist who also has this training. PM me with where you are and if i know someone close i'll recommend them.
    mc
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    Pain in Upper body neck and shoulders

    Hello Sir,
    I have got a problem for which i need your help/advise. I am age 28. I started strength training with a 2 day split prog. After about 6 weeks of time I started to have pain in my collar bone , shoulder and rear upper back region. Pain persisted for 2 days so I went to see a doctor who advised me to take complete rest and no workout for 1 month (in Oct-2011). I took rest in fact upto Dec 2011, and some medicines as advised by doctor. When In new year I returned and started exercise after 2 days, the pain again re-surfaced, and I did not went since 03-Jan-12. I don't know what to do. Please advise some diagnosis or test or what i can do.. ?
    Thanks In advance.
    Shiv
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    Originally Posted by shivprakash1980 View Post
    Hello Sir,
    I have got a problem for which i need your help/advise. I am age 28. I started strength training with a 2 day split prog. After about 6 weeks of time I started to have pain in my collar bone , shoulder and rear upper back region. Pain persisted for 2 days so I went to see a doctor who advised me to take complete rest and no workout for 1 month (in Oct-2011). I took rest in fact upto Dec 2011, and some medicines as advised by doctor. When In new year I returned and started exercise after 2 days, the pain again re-surfaced, and I did not went since 03-Jan-12. I don't know what to do. Please advise some diagnosis or test or what i can do.. ?
    Thanks In advance.
    Shiv
    usually only post on one thread at time, and, as suggested elsewhere, seek out a pro for a movement assessment and recommended rehab work.
    http://www.begin2dig.com/2010/11/wha...for-petes.html

    best
    mc
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    Registered User shivprakash1980's Avatar
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    Originally Posted by mc- View Post
    usually only post on one thread at time, and, as suggested elsewhere, seek out a pro for a movement assessment and recommended rehab work.


    best
    mc
    Hi,
    Am sorry for multiple posts. I was in a mental state of frustration and was feeling very sad. In my place/town I do not have facility of sports physio or professional. I think i have to move to some other big town to get the problem checked.

    It normally not pains much but moving hand overhead increases the pain in shoulder and rear back region.

    Anyways, thanks for your time and reply.
    bye
    Shiv
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    this is great bc I would say the shoulder is probably the most nagging injury you can get. Great post
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    Nice post! I recently injured my left shoulder and am slowly getting the ROM back now.
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    Great thread.

    Recently had a subacromial decompression done to remove a bone spur that was fraying my subscapularis.
    I'm in week 4 of rehab now, and it's seeming that I've also got some biomechanical issues going on, so this is all relevant to me.
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    I have this little "crick" in my shoulder. It only bothers me on dumbell shoulder press when I get to the last few inches of full extension. I can still lift as heavy as I can but after one set of lifting heavy I have to drop down in weight because the "crick" doesn't allow me to balance the weight and if I push it and go full extension anyway it hurts with a sharp pain. I don't think it's a rotator cuff problem because I do all my other shoulder exercises without issue. It only appears on the shoulder presses. Any ideas how to work around/through/correct this problem? Shoulder routine consists of seated dumbell press, front and side lat raises, standing upright rows, rear delt spread(not sure of the name but on the pec deck), and shrugs. Any advice is majorly appreciated.
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    hey man great info i will definitly use this to prevent my shoulders from injury.
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